Skip to content
MENUMENU
  • HOME /
  • BLOG /
    • Jr. NADmag
    • 2020 Summer Series
    • YLC Daily Drum
  • COBO /
    • HISTORY
    • How To Play
    • Archived Questions
  • YLC /
    • YLC History
    • YLC Program
    • 2023 YLC Camper Forms
      • YLC Tuition Payment
      • Camper Agreement
      • Camper Medical Release and Consent
      • Camper’s Health Form
      • Camper’s Travel
    • 2023 YLC Staff
      • Staff Info & Public Release Form
      • Staff Medical Release and Consent
      • Staff Health Form
      • Staff Travel Form
    • Frank R. Turk YLC Scholarship Fund
  • PITCH COMPETITION /
    • YAP History
    • Timeline
    • Eligibility Requirements
    • Affiliated Organizations, Local, or State Association Competition Guidelines
    • VIS
    • MDAAP History
  • Jr. NAD /
    • Jr. NAD Portal
    • Jr. NAD History
    • Jr. NAD Core
    • Jr. NAD Pages
    • Past Chapters
    • Jr. NAD Conference
      • #2022JrNADVibes
      • #JrNAD2019
      • #JrNAD2017
    • Jr. NAD Delegates
    • Metro Jr. NAD
  • National Deaf Youth Day /
  • Events /
  • DONATE /
  • CONTACT
NAD Youth ⁄ Youth Leadership Camp ⁄ 2023 YLC Staff ⁄ Staff Health Form

2023 YLC Staff Health Form

  • To be completed by a staff member’s doctor/physician by June 10, 2023. Physical exams made before July 23, 2023 will not be accepted. If you have any questions about this form please email [email protected] with subject header "YLC Staff Completed Health Form".
  • MM slash DD slash YYYY
  • MM slash DD slash YYYY
  • Please check if the staff member had any of the following health problems. If you checked yes, please explain the comment box provided below.
  • MM slash DD slash YYYY
  • Please list ALL of your immunization shots including year(s) of immunization and last booster.
    (e.g. Tetanus/Diphtheria - shot 1998, booster 2008)

    Here's a list of typical shots:
    Tetanus/Diphtheria
    Tetanus (alone)
    Oral Polio (Sabin)
    Injectable Polio (Salk)
    Measles (Rubeola)
    Measles (Rubella)
    Mumps
  • By submitting this form, I certify that I have on this date examined the above named staff member and that on the basis of my examination and the medical history as furnished to me, I have found no reason that would make it medically inadvisable for this staff member to participate in physically strenuous activities.
  • Reset signature Signature locked. Reset to sign again

Office Address

National Association of the Deaf
c/o Youth Programs
8630 Fenton St. Suite 820
Silver Spring, MD 20910

Connect with Us!